Background. Electroconvulsive therapy (ECT) is the only treatment method used in psychiatry before the era of modern psychopharmacology that managed to survive till present. This was possible since ECT is both safe and highly effective. Although the range of its applicability has been considerably reduced, in most cases when applied ECT is more effective than standard pharmacotherapy. The paper presents an overview of clinical studies on ECT effectiveness in the treatment of depressive disorders, at present the main recommendation for the use of this technique.
Views. A vast majority of clinical studies corroborate ECT efficacy in the treatment of depressive disorders. This pertains both to older studies using sham stimulation (active placebo), and in more recent controlled trials where ECT efficacy was compared to that of reference antidepressants. ECT is considered to be more effective than antidepressants (60-85% vs. 60-65%, respectively), particularly in severe depressive syndromes, including these with psychotic features. The effect of stimulation parameters on ECT effectiveness, and the place of ECT in refractory disorders were outlined.
Conclusions. ECT as a stable element in the management of severe depressive syndromes should be included in the treatment plan at a specific stage of the therapeutic ladder. Effectiveness of ECT outweighs inconveniences associated with this method, side effects, and ethical objections.